Preface
As was pointed out in the first of the two volumes which make up the thoracic surgery series in the history of the U.S. Army Medical Department in World War II, the fact that the story could not be told in one volume is a reflection of how this specialty came of age in the Second World War.
The first of the thoracic surgery volumes includes a historical note; the general, including the statistical, background of thoracic injuries; administrative considerations in the Mediterranean and European theaters and in the Zone of Interior; and the routine of management of war wounds of the chest from emergency care on the battlefield to rehabilitation in a thoracic surgery center.
This second volume deals with the special types of thoracic wounds caused by the missiles of modern warfare and with the management of their complications. As noted in volume I, the Pacific experience will be related in the volume dealing with surgery in the Asiatic-Pacific theater.
Special attention is devoted in volume II to certain complications of these injuries whose significance was realized, or fully realized, for the first time in World War II.
Retained foreign bodies have always constituted a fascinating phase of military chest surgery, though their management has not always been as discriminating, and therefore as successful, as it eventually became in this war. The series of 134 operations performed by Lt. Col. Dwight E. Harken, MC, in which foreign bodies were removed from the heart and great vessels, constitutes a remarkable achievement. There were no deaths in the series, and all of the patients left the chest centers with normally functioning hearts. The cardiac and cardiovascular operations performed at this and other chest centers during the war helped to lay the foundations for the almost miraculous advances in this field since the war.
The concept of wet lung was developed in World War II by Maj. Thomas H. Burford, MC. The methods devised to combat it prevented graver subsequent complications of chest wounds. As a result, the huge morbidity that had attended these injuries in World War I was eliminated, and many lives were undoubtedly saved.
Hemothorax was recognized in World War II as one of the important complications of chest wounds and as an antecedent of the more serious complications of organizing and infected hemothorax and hemothoracic empyema. Prompt and adequate aspiration of the chest was a simple and uniformly applicable measure of management that eventually came into general use.
Decortication proved the solution in patients with hemothorax which went on to organization and infection because of bad management, or in spite of sound management. The operation had been employed earlier for the type
of empyema usual in civilian life, but not for complicationsof wounds of the chest. Its bold and imaginative application to organizedhemothorax and hemothoracic empyema by Major Burford was attended with such goodresults that the operation promptly came into general use throughout thetheater.
It is a tribute to the excellent quality of the chest surgery done overseasthat, after the first months of the war, relatively little active treatment wasrequired by the thoracic casualties evacuated to Zone of Interior hospitals. Thethoracic cripples who thronged these hospitals after World War I were almostnever observed in World War II.
By tradition, a history of military medicine in any particular war has endedwith the end of the fighting. There have been almost no attempts to determinethe postwar results of special methods of treatment. Particular attention is therefore directed to the final chapter in thisvolume, which deals with the clinical and roentgenologic followup, in 1960 and1961, of 167 casualties who sustained chest wounds in the 1943-45 period. Therecorded data represent an incredible amount of time and effort on the part ofmany persons and agencies, but the followup was entirely the inspiration, andchiefly the work, of Dr. Lyman A. Brewer III, formerly Maj., MC. It was apractical effort because the groundwork for it had been laid during the war:While Dr. Brewer was serving as a thoracic surgeon with the 2d AuxiliarySurgical Group in the Mediterranean theater, he kept an individual record foreach casualty he cared for personally. The selection of the patients whom it wasconsidered practical to followup in 1960 and 1961 was made from this material.
This long-term followup study is a unique and praiseworthyendeavor. It is unfortunate that more such attempts have not been made. Theexcellent clinical and roentgenologic status of these casualties and theiractive engagement in the normal activities of civilian life give testimony, asDr. Brewer concludes, to the management of critical thoracic wounds during WorldWar II by the policies and practices described in these two volumes.
As was pointed out in the preface to the first of these twovolumes, it would be impossible to produce books of the range of these volumeson thoracic surgery without the painstaking and devoted assistance of a greatmany persons and agencies. In the end, for a variety of reasons, the chiefresponsibility for the preparation of this material fell upon a relatively smallnumber of authors. It is a pleasure again to make acknowledgment to them:
Dr. Brian Blades (formerly Col., MC), Consultant in ThoracicSurgery to The Surgeon General and Chief, Thoracic Surgery Section, Walter ReedGeneral Hospital, Washington, D.C., during World War II.
Dr. Brewer, who served with Team No. 2, 2d Auxiliary Surgical Group, in theMediterranean theater and later in the European theater.
Dr. Burford, who served with Team No. 3, 2d Auxiliary Surgical Group, in theMediterranean theater.
Dr. B. Noland Carter (formerly Col., MC), Assistant Director, SurgicalConsultants Division, Office of The Surgeon General. Dr. Carter, in addition
to preparing the chapters which carry his name, reviewed the entiremanuscript and made many helpful suggestions.
Dr. Michael E. DeBakey (formerly Col., MC), Chief, General Surgery Branch,Surgical Consultants Division, Office of The Surgeon General, and now Chairmanof the Advisory Editorial Board for Surgery.
Dr. Harken, Regional Consultant in Thoracic Surgery to the Senior Consultantin Surgery, European theater. Dr. Harken also directed the chest center at the160th General Hospital, Stowell Park, Gloucestershire.
A large part of the artwork was Dr. Brewer's original conception, and hedirected the preparation of all of it from beginning to end.
Mr. Milton C. Rossoff, formerly Assistant Chief, Statistical Analysis Branch,Medical Statistics Division, Office of The Surgeon General, collected andtabulated the official statistics for the thoracic surgery volumes.
My grateful appreciation is due to Mrs. Ethel Bauer Ramond, who served asassistant to the Associate Editor and who typed the entire original manuscriptwith notable speed, accuracy, and real medical intelligence.
Grateful acknowledgment is also due to a number of the personnel of TheHistorical Unit, U.S. Army Medical Service:
Maj. Albert C. Riggs, MSC, formerly Chief, General Reference and ResearchBranch, and Mrs. Esther E. Rohlader, Assistant Chief, provided much of the basicdata for these volumes and patiently and efficiently answered endless queriesand tracked down numerous obscurities to their final solution.
Mrs. Pauline B. Vivette, Assistant Chief, Editorial Branch, prepared bothvolumes for publication and, with the assistance of Mrs. Martha R. Stephens,Editor (Printed Media), prepared the artwork and its layouts in editorial stylefor the printer.
Mrs. Hazel G. Hine, Chief, Administrative Branch, handled the multipledetails connected with the preparation of volumes issued under Governmentauspices and also supervised the final typing of the manuscript.
Finally, a special word of appreciation is due to two other persons whoworked on these volumes:
Miss Elizabeth M. McFetridge, Associate Editor for the surgical series ofvolumes, who, after many discouragements, was able to bring together thematerial prepared by the group of thoracic surgeons who worked in theMediterranean and European theaters and to prepare it for publication.
Col. John Boyd Coates, Jr., MC, former Director, TheHistorical Unit, U.S. Army Medical Service, and Editor in Chief of the historyof the U.S. Army Medical Department in World War II. Colonel Coates, who servedin World War II as Executive Officer, Medical Division, Third U.S. Army, saw theunfolding of the story of thoracic surgery in the European theater and, duringthe campaign, was in frequent contact with the Consulting Surgeon, Sixth U.S.Army Group. His firsthand knowledge has been useful, and his cooperation in allthe work on these two volumes has been most helpful.
FRANK B. BERRY, M.D.
